complex patterns again/food for thought

[Guest guest]

Ze'v,

the distinction of patterns and complex diagnosis is

an issue that applies particularly when treating

patients with cancer or chronic immune conditions. The

patients constitution, location of the disease,

pathomechanism leading to its development.

 

I welcome this descussion and would love to sharpen my

diagnostic skills through case evaluations.

 

This could also become a forum for developing case

presentation guidelines, as well.

 

Eti Domb

 

 

--- <zrosenbe wrote:

> I wanted to reopen a topic of interest that I never

> felt was clearly

> resolved when it made the rounds a few months ago.

> This was the use of

> complex multi- pattern diagnosis as suggested by the

> work of Li

> Dong-yuan, and in the work of the early 20th

> century Chinese physician

> Zhang Xi-chun. In my recent reading of Volker

> Scheid's " Contemporary

> in China " (Duke University Press,

> 2002), the case

> histories of a Professor Zhu caught my interest.

> Throughout the book,

> it is apparent that at least the work of some

> laozhongyi/venerable

> Chinese physicians has been greatly influenced by

> Zhang Xi-chun's work.

> In one of Professor Zhu's cases, he uses a

> multi-pattern approach to a

> patient with stubborn abdominal distention and pain,

> and points out the

> need for a multi-step, complex pattern

> differentiation to treat what a

> simple/single pattern differentiation and

> prescription have failed to

> alleviate. Because of space limitations, I will

> refer interested

> parties to the text itself.

>

> One interesting aspect of Zhang Xi-chun's work was

> his adding of Li

> Dong-yuan's concept of ascending (of clear yang and

> spleen qi) and

> descending (of turbid yin and stomach qi) to the ba

> gang/eight

> parameters (principles).

>

> Secondly, I was taken with the section on bian

> zheng/pattern

> differentiation, especially in the development of

> post-war Chinese

> medicine in mainland China.

>

> It appears from the text that one of the debates in

> the development of

> modern CM is between a more in-depth, complex system

> of pattern

> diagnosis and a simpler method utilizing xing or

> types. In xing/type

> analysis, disease differentiation is divided into a

> limited number of

> simple patterns and appropriate prescriptions. This

> method is quite

> prevalent in English language CM textbooks. What

> distinguishes it from

> the more complex pattern differentiation is the

> real-time naming of a

> disease and determining of a specific single pattern

> to treat it.

> Whereas in more complex pattern differentiation, one

> has to include the

> history and development of the disorder, the

> constitution of the

> patient, transmutation of the disease process, and

> include all

> presenting symptoms and signs of the patient. This

> method is more work

> for the practitioner than simple type

> identification.

>

> Quotes from the text:

>

> " A pattern expresses four core aspects of disease

> development: 1)

> causation/bing yin, location/bing wei,

> pathomechanism/bing ji and

> character/bing xing. These express the unfolding

> of process rather

> than the manipulation of bonded structures. " (pg.

> 201).

>

> More (pg. 226):

> " Western medicine disease categories were now

> suggested as primary

> diagnostic signposts. Each biomedical disease was

> to be subdivided into

> several distinct Chinese medicine patterns, now

> referred to as 'types'

> (xing) rather than 'patterns' (zheng). For each type

> specific treatments

> were then suggested. "

>

> (pg 227):

> " Merely matching formulas with symptoms and signs

> classified as types

> represents a vulgarization of Chinese medicine,

> which kills it off

> precisely because it fails to grasp its practice. "

>

> The difference between typing and true pattern

> differentiation, in my

> opinion, is at the crux of the argument of simple

> one-pattern diagnoses

> and multi-pattern diagnoses.

>

> If this discussion develops, I will give more

> in-depth derivations from

> the text, and discuss this interesting problem with

> the focus it

> deserves. Volker's book certainly asks us to

> examine our points of view

> and reconsider what we think Chinese medicine is all

> about.

>

>

>

>

 

 

=====

AcuClinic: Acupuncture and Herbs

Eti Domb, L.Ac.

1281 University Ave, Suite E

San Diego, CA 92103

619.543.9280

 

 

 

- Official partner of 2002 FIFA World Cup

http://fifaworldcup.

[Guest guest]

The difference between typing and true pattern differentiation, in my opinion, is at the crux of the argument of simple one-pattern diagnoses and multi-pattern diagnoses

>>>>>I am still not sure what people mean by multi pattern. Are we talking about the development of peripheral syndromes such as Sp def leads to damp accumulation which stagnates and turns into Damp-Heat with underlying Sp deficiency. To me this is not a multi-pattern just normal patho mechanics. Or are we talking about multiple "diseases"with each having their own pattern. Or multiple systems affected by the same patho mechanics. Or just because the patients has many symptoms and we may feel that we have to fit them into pre-fixed ideas of patterns, and we are not sophisticated enough to understand what is the common thread within them so we pile them up.

I have seen people able to explain any symptom within any complex and Organ they want to in order to explain away their rational and thus avoid having so called multi-patterns. Certainly my SH teacher was that way. Personally I have found that often the more complex a condition looks the better I do with a simpler herbal approach.

Alon

[Guest guest]

, " " <zrosenbe@s...>

> One interesting aspect of Zhang Xi-chun's work was his adding of

Li Dong-yuan's concept of ascending (of clear yang and spleen qi)

and descending (of turbid yin and stomach qi) to the ba gang/eight

> parameters (principles).

 

 

Z'ev:

 

You are very ambitious to bring up this issue. Most TCM " diagnosis, "

even those trying to represent and express patterns (bianzheng

lunzhi), typically reduce any problem to one or several simple

rubrics (e.g. spleen xu). To me, this seems actually contrary to

Scheid's (and Sivin's and Farquhar's) impression regarding " Chinese

medicine's concern for patterns . . . organized around the unfolding

of process rather than the manipulation of bounded structures "

(p.201). I would think that 5-Phases (not the Worsley adaptation)

would better serve as the context for bianzheng lunzhi, but it's

largely unheard of in TCM.

 

Qin Bowei also wanted to enlarge the ba gang, but I don't think even

he went far enough. Like him, I would oppose the " catagorical

separation between diseases, patterns, and symptoms proposed in the

Outline. " It's interesting that Qin argued on the basis of

lexicographical evidence that the classical terms evidence, symptom,

and pattern were " equivalent and often used interchangeably. "

 

Without including biochemical processes as discussed in Western

medicine, we would never see the root of disorders like cystic

fibrosis (misfoded protein), AIDS (virus), etc.

 

 

Jim Ramholz

[Guest guest]

In , " " <zrosenbe@s...> wrote:

> I would also add that many CM physicians follow the pattern

differentiation model of Fang Yaozhong, discussed in the appendix of

Scheid's book, which includes five phase differentiation. He uses

the five phase relationships in the generation of disease states,

and also in preventing disease from reaching healthy visceral

systems. A more inclusive model than Qin Bo-wei's in my opinion.

 

 

Z'ev:

 

You're right. It is more detailed than Qin; even after Qin increased

the criteria from 8 Principles to 14. Perhaps Fang's 7 steps should

be made the new standard for clinical descriptions on this forum?

 

But Fang's inclusion from 5-Phases is, disappointingly, very basic;

perhaps some of the stigma is still attached. What seems to be

missing are all the details on 5-Phases found in the classics---

especially the Suwen (espcially Chaps 66f), Nan Jing, and Mai Jing.

It seems that the Chinese themselves do not fully utilize all the

information available. I suspect more so due to their struggle for

the independence and modernization of their medical tradition in

light of Western medical encroachment.

 

 

Jim Ramholz

[Guest guest]

I wanted to reopen a topic of interest that I never felt was clearly

resolved when it made the rounds a few months ago. This was the use of

complex multi- pattern diagnosis as suggested by the work of Li

Dong-yuan, and in the work of the early 20th century Chinese physician

Zhang Xi-chun. In my recent reading of Volker Scheid's " Contemporary

in China " (Duke University Press, 2002), the case

histories of a Professor Zhu caught my interest. Throughout the book,

it is apparent that at least the work of some laozhongyi/venerable

Chinese physicians has been greatly influenced by Zhang Xi-chun's work.

In one of Professor Zhu's cases, he uses a multi-pattern approach to a

patient with stubborn abdominal distention and pain, and points out the

need for a multi-step, complex pattern differentiation to treat what a

simple/single pattern differentiation and prescription have failed to

alleviate. Because of space limitations, I will refer interested

parties to the text itself.

 

One interesting aspect of Zhang Xi-chun's work was his adding of Li

Dong-yuan's concept of ascending (of clear yang and spleen qi) and

descending (of turbid yin and stomach qi) to the ba gang/eight

parameters (principles).

 

Secondly, I was taken with the section on bian zheng/pattern

differentiation, especially in the development of post-war Chinese

medicine in mainland China.

 

It appears from the text that one of the debates in the development of

modern CM is between a more in-depth, complex system of pattern

diagnosis and a simpler method utilizing xing or types. In xing/type

analysis, disease differentiation is divided into a limited number of

simple patterns and appropriate prescriptions. This method is quite

prevalent in English language CM textbooks. What distinguishes it from

the more complex pattern differentiation is the real-time naming of a

disease and determining of a specific single pattern to treat it.

Whereas in more complex pattern differentiation, one has to include the

history and development of the disorder, the constitution of the

patient, transmutation of the disease process, and include all

presenting symptoms and signs of the patient. This method is more work

for the practitioner than simple type identification.

 

Quotes from the text:

 

" A pattern expresses four core aspects of disease development: 1)

causation/bing yin, location/bing wei, pathomechanism/bing ji and

character/bing xing. These express the unfolding of process rather

than the manipulation of bonded structures. " (pg. 201).

 

More (pg. 226):

" Western medicine disease categories were now suggested as primary

diagnostic signposts. Each biomedical disease was to be subdivided into

several distinct Chinese medicine patterns, now referred to as 'types'

(xing) rather than 'patterns' (zheng). For each type specific treatments

were then suggested. "

 

(pg 227):

" Merely matching formulas with symptoms and signs classified as types

represents a vulgarization of Chinese medicine, which kills it off

precisely because it fails to grasp its practice. "

 

The difference between typing and true pattern differentiation, in my

opinion, is at the crux of the argument of simple one-pattern diagnoses

and multi-pattern diagnoses.

 

If this discussion develops, I will give more in-depth derivations from

the text, and discuss this interesting problem with the focus it

deserves. Volker's book certainly asks us to examine our points of view

and reconsider what we think Chinese medicine is all about.

 

 

[Guest guest]

Z'ev:

 

Will any of this be considered by COMP, too?

 

Jim Ramholz

 

 

 

 

 

, " " <zrosenbe@s...>

> It appears from the text that one of the debates in the

development of modern CM is between a more in-depth, complex system

of pattern diagnosis and a simpler method utilizing xing or types.

In xing/type analysis, disease differentiation is divided into a

limited number of simple patterns and appropriate prescriptions.

This method is quite prevalent in English language CM textbooks.

What distinguishes it from the more complex pattern differentiation

is the real-time naming of a disease and determining of a specific

single pattern to treat it.

> Whereas in more complex pattern differentiation, one has to

include the history and development of the disorder, the

constitution of the patient, transmutation of the disease process,

and include all presenting symptoms and signs of the patient. This

method is more work for the practitioner than simple type

identification.

[Guest guest]

I agree with all of your points, Jim.

 

I would also add that many CM physicians follow the pattern

differentiation model of Fang Yaozhong, discussed in the appendix of

Scheid's book, which includes five phase differentiation. He uses the

five phase relationships in the generation of disease states, and also

in preventing disease from reaching healthy visceral systems. A more

inclusive model than Qin Bo-wei's in my opinion.

 

 

On Friday, June 28, 2002, at 12:38 PM, jramholz wrote:

 

> , " " <zrosenbe@s...>

> > One interesting aspect of Zhang Xi-chun's work was his adding of

> Li Dong-yuan's concept of ascending (of clear yang and spleen qi)

> and descending (of turbid yin and stomach qi) to the ba gang/eight

> > parameters (principles).

>

>

> Z'ev:

>

> You are very ambitious to bring up this issue. Most TCM " diagnosis, "

> even those trying to represent and express patterns (bianzheng

> lunzhi), typically reduce any problem to one or several simple

> rubrics (e.g. spleen xu). To me, this seems actually contrary to

> Scheid's (and Sivin's and Farquhar's) impression regarding " Chinese

> medicine's concern for patterns . . . organized around the unfolding

> of process rather than the manipulation of bounded structures "

> (p.201). I would think that 5-Phases (not the Worsley adaptation)

> would better serve as the context for bianzheng lunzhi, but it's

> largely unheard of in TCM.

>

> Qin Bowei also wanted to enlarge the ba gang, but I don't think even

> he went far enough. Like him, I would oppose the " catagorical

> separation between diseases, patterns, and symptoms proposed in the

> Outline. " It's interesting that Qin argued on the basis of

> lexicographical evidence that the classical terms evidence, symptom,

> and pattern were " equivalent and often used interchangeably. "

>

> Without including biochemical processes as discussed in Western

> medicine, we would never see the root of disorders like cystic

> fibrosis (misfoded protein), AIDS (virus), etc.

>

>

> Jim Ramholz

>

>

>